Integrated Nurse Case Manager

• Accepts responsibility and accountability for achievement of optimal outcomes within their scope of practice
• Advocates on behalf of patients and caregivers for identification and access to services
• Identifies and manages other patient needs making referrals to the appropriate personnel
• Assures prudent utilization of all resources (fiscal, staff resources, environmental, equipment and services) by evaluating the options available
• Reviews all assigned Outpatient Observation patients and verifies correct status assignment and develops discharge plan
• Conducts admission and continued stay reviews to evaluate medical necessity of admission/continued stay and appropriateness of treatment plan
• Facilitates external payer certification for hospital and discharge needs
• Initiates the process to move the patient appropriately through the continuum of care
• Communicates timely, relevant and accurate information to all parties involved with patient's care
• Facilitates the progression of care by advancing the care plan to achieve desired outcomes
• Uses critical thinking skills to facilitate proactive discharge planning
• Identify discharge needs such as equipment, home health services, nursing home, and etc.
• Completes education and resource referrals as appropriate
• Facilitates transfers to a lower level of care
• Explores discharge options and communicates to the patient, family and physician
• Coordinates and facilitates communication among all team members, including community providers
• Integrates the work of the healthcare team by coordinating resources and services necessary to accomplish agreed-upon goals and desired discharge plan
• Documents appropriate information in Case Management computer system, progress notes and any other required documentation
• Prepares for and participates in daily Interdisciplinary Care Coordination (ICC) Huddles
• Works collaboratively with patients, families, all members of the healthcare team, and community partners to make an appropriate discharge plan
• Presents at the Weekly Length of Stay (LOS) Meeting on patients reaching or surpassed the assigned length of stay threshold
• Facilitates care within the financial restraints
• Prioritizes daily activities based on payer reimbursement, length of stay, level of care, and charges to date
• Intervenes per hospital/department policy with potential over-utilization of clinical resources
• Assists in the appeal process by proactively requesting reconsideration on all adverse determinations from external payers
• Identify, escalate, and document avoidable days for reporting purposes
• Provide crisis intervention as needed/when directed by Case Management Director/Manager
• Continually participates in the study and improvement of process providing health care services to meet the needs of patients, the organization and the department
• Monitors individual patient outcomes and intervenes as necessary
• Identifies opportunities for performance improvement and refers to the appropriate person or department
• Identifying opportunities for Medical Staff performance improvement, collecting data, reporting variances and statistical data to the Medical Staff Performance Improvement Committee, Credentialing Committee, or any other appropriate group or team
• Assist the medical staff department with conducting peer review activities and completion of special studies
• Serves as a resource for the PI process, and is able to lead team and facilitate teams
• Completes all Case Management system requirements, and assist in data analysis and identifying opportunities to improve performance
• Monitors outcomes related to the financial impact on patient care
• Participates in professional development activities
• Acts as a preceptor for new team members
• Assists in training of new team members
• Seeks clinical supervision when needed
• Demonstrates flexibility and teamwork among case management staff members
• Assists peers in the event of fluxuating census
• Provides coverage to other services as needed or as requested by Manager
• Identifies, monitors and reports opportunities for quality and performance improvement to the appropriate department

• High School Graduate
• Bachelor Degree Nursing in Nursing
• Licensed Registered Nurse (LRN) - Single State - State Board of Nursing Registered Nurse in State of Kansas

2 or more years clinical experience in a health care setting